Daniel: Welcome to “The Future Adjustment,” Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the Editor-in-Chief of “Chiropractic Economics,” and our guest today is Madeleine Silva, who’s found remarkable success in the highly competitive arena of healthcare business coaching, particularly for complementary and holistic providers. She’s also the co-founder of The Empowered Healthcare Revolution. She understands that disruption is happening in healthcare just as it is in nearly every other industry. And she’s a renowned speaker to audiences who want to stay ahead of the curve. Madeleine Silva, It’s a pleasure to welcome you to our podcast.

Madeleine: Thank you so much, Daniel, I’m thrilled to be here.

Daniel: Okay, well, you have your finger on the pulse of so many interesting things, so let’s just get to them. Your knowledge of disruption and the shifting business landscape is more than academic, you confronted it in your own business. Can you tell us a little about your backstory?

Madeleine: Yeah, absolutely, so about 16 years ago, I started a insurance billing and practice management consulting company, primarily working with chiropractors. And, you know, I quickly grew it and it was very successful, I had some really powerful partners in that business and it was really fun, I loved it. And then big changes, big industry changes happened in the insurance industry and anybody who’s dealt with insurance knows what a headache it can be.

And all of a sudden, I lost 35% of my profit margin just like that. And up to that point, I was working many hours, I was working maybe 50, 60 hours a week, the typical, you know, small business owner. And the silver lining of all of that was that I had a really good cash flow. And then when that shift happened and that was taken away, too, it was really, incredibly stressful and I tried to tweak. I mean, working with the insurance industry, things are always changing so you’re always pivoting and trying to move with the economy, but the little tweaks I was making was just not making a difference. And pretty quickly, because I now had lost my main income source, and like many women these days, I think 29% of all women these days, I was the sole breadwinner of my family and so without my income, we pretty quickly spiraled downward.

And by just pure luck, I think, we were able to sell our home, our house that we owned, and get out before we actually lost that to the banks. We were starting to get pre-foreclosure paperwork from the banks. And so we had, you know, so there I was middle of the night, lying in bed, sleepless, staring at the ceiling, really stressed out. And we have made a little bit of money from the sale of the house. And so as I was staring there in our little rental, I was like, “Okay, I have to make this work, I have to commit,” and I made that commitment, put my stake in the future and said, “I’m gonna turn my business around.”

I mean, I didn’t have a lot a lot of choice, really, right?. So the next day, I sat my husband down and I said, “Listen, I want to take half of what we made from the business. I mean, from the sale of our house and invest it into my then failing business. And that would leave us, you know, a tiny bit of money left over that would if we stretched it out, we might be able to live off for the next six months and then we would run out of money again.”

And so he was, you know, amazing guy, he actually said yes, and so I started, you know, I went back to my office and I still didn’t really know what I needed to do, or what I need to change. And a couple of days later, I received a letter in the mail that totally changed everything and it was a letter from a business broker.

And he was specialized in selling businesses like mine, insurance, recurring insurance billing services, recurring businesses. And so I reached out to him and he gave me three things that I needed to have in place in order to sell my business at the price that I wanted, that I made up. And he said, you know, I had to be able to run the business from anywhere and I needed to have X-dollar profit margin and it needed to be able to run without me.

And at the time, I had an expensive office lease, I had eight full-time local employees. I had, you know, not making…I was making good money and our revenue was really good, but I wasn’t making any profit anymore, right? And so at that time, I just started really looking and I feel like I did a paradigm leap in my own mind and started looking at my business from a completely different point of view. Because, like I said, I was working 50 or 60 hours work weeks that I wasn’t really sure how the business was gonna be able to run without me.

And so I started making some really radical changes and really looking at the business differently and within the next six months, I worked myself out of a job and ended up with an eight-hour work week. And I ended up with a 65% profit margin and I went primarily from a brick and mortar business into a virtual business. And I did that and then we’re able to sell it for the exact dollar amount actually that I gave that broker that day.

Daniel: Hey, a happy ending.

Madeleine: I know, a really happy ending, and so I understand the challenges of today’s brick and mortar businesses and I understand the challenges of disruption that happens outside of your control. I mean, these decisions in the insurance industry was made way above my pay grade, right? At government levels, so I understand what the chiropractor in today’s, you know, office… And yeah, and I might not be able to go virtual, but there’s lots of really creative ways of looking at the business. And I also think, you can no longer rely on making minor tweaks in your practice, you need to make that paradigm leap. A different way of practicing.

Daniel: Yes, let’s explore some of that in a second. I just wanted to say that from some of the things that you were saying, you reminded me of that series of books called “The E-Myth Revisited.”

Madeleine: Yes.

Daniel: Yeah, that doctors of chiropractic are vulnerable to this problem because often the practice is driven by the personality of the owner. And the practice never develops these systems in place that would allow the practice to be sold as a turnkey operation because it’s really built around the personality and the popularity, and the charisma, of the founding doctor. And so it seems like you’ve kind of put your finger on the importance of establishing systems so that the practice can run whether you’re there or not. And there’s no question that the doctor-patient relationship is undergoing some changes now. It used to be the doctor was sort of the premier authority and the patients had to be extremely deferential. And that seems to be changing because of the internet. Do you have any thoughts on that for us?

Madeleine: Yeah, absolutely, and I’m so glad that you’re actually acknowledging that the patient-doctor relationship is really changing. Because I think a lot of times when we talk about healthcare disruption, we overlook that part. We talk primarily about innovation and technology and online marketing, but I think that biggest piece is actually that the doctor-patient relationship that’s just changing. And what I’m noticing is really patients are changing in five key ways, one, that I think they’re more skeptical than ever before. Now getting bombarded with offers and sales online and, you know, being promised the sky and the stars.

And I think that they really are looking to know, like, and trust somebody before they’re actually willing to come in and see you. And I think even with referrals, it’s harder to convert people. And I also think that they’re way more demanding than ever before, meaning that they’re really looking to be empowered and get knowledge. And they want somebody that’s gonna partner with them in their healthcare, and they are way more educated than before. They ask more questions because with the digital disruption, they have now access to all of this amazing information online. 80% of adults are now researching online before they seek out a provider. 94% read online reviews and they consider online reviews just as credible as a direct referral from a family member.

So, you know, they are highly educated and they’re hanging out on hubs online looking at solutions for healthcare. So they walk into your practice pretty much right with a folder underneath their arm ready, armed with knowledge and with lots of questions. And I also think they way more holistically focused, so, I mean, obviously, this is a fantastic thing for chiropractors, right? But I think that they really waking up that medications and surgery is not the solution, it’s definitely not a long-term solution. And that they’re really looking to find different answers to health concerns. And I also believe that patients are more than ever want to participate in their own healing, they don’t want things so much done to them, they don’t want to be fixed as much as they actually want to be engaged. And better understand and learn from the healthcare provider they’re working with.

Daniel: Yeah, I’ve gone into the doctor’s office with a folder under my arm, like, so guilty as charged.

Madeleine: Right?

Daniel: Right, and, of course, there are the online review tools, as well. A dissatisfied patient has a lot more power nowadays. Because he or she doesn’t just, you know, tell their friends about an experience they had, but they can get online and tell the whole world about it. So that’s definitely changing things there. One problem that is common to most doctors of chiropractic is just a hard limit on the number of patients they can see in a day. How can they get…give me tips on how they can get beyond a linear growth pattern and experience the kind of exponential growth that you talk about in your seminars?

Madeleine: Yeah, absolutely. I mean, you kind of touched on it earlier when you were talking about how the chiropractor, and I also said this for years that I think that chiropractic is in a very unique position because other, if you look at other six or seven-figure or even eight-figure business owners, none of them are actually responsible for the day to day promises of their businesses anymore, right? But a chiropractor is there face to face with a patient adjusting and that’s the main promise of that practice. So I think that the long-term goal is to step out of that role of being the center of your practice and, like you said, personality-driven practicing and rely on other people to take some of those pieces. Now how do you do that well? So one of the things that I’m talking a lot and teaching some of my clients is, really, you have to figure out a membership-style practice and I’m not talking about the joint or discounting your chiropractic services.

So obviously, if you discount your face to face services, you are quickly not gonna be able to create exponential growth, but you quickly actually gonna now just discounting your services. So that’s not the solution, but just like I talked about before, patients are really looking for education and resources and community-based online networks and I believe that chiropractors should create online communities. And they can simply monetize those, as well, and create memberships as a business model that actually covers your basic overhead expenses. So imagine if your overhead was covered by recurring membership income by people, a community of people that you establish yourself as the expert and leader of. And it also becomes, very quickly, a place where you are the expert and obviously, the leader of that community which positions you and gives you a tremendous amount of social proof. New patients are definitely gonna seek you out from that community and you’re gonna get way more referrals because you’re now a key influencer. And it opens doors to other speaking gigs, and podcast interviews and just local influencers are gonna start reaching out to you. It creates this place where people find you and get to know you better.

Daniel: Yes, and for our listeners out there who may be, like, thinking, “Well, that sounds kind of like a wild idea,” actually, there are some doctors out there right now who are doing exactly what you’re describing, they’re building a strong online community. They develop a fan base, if you will, and they’ve created the spaces for patients to come together and share their own insights and knowledge. And it’s a very powerful technique and it is definitely doable and there are people who are very good at it. Dr. Axe comes to mind. There’s a few more.

But this does lead us to the kind of another topic I wanted to ask you about quickly because it’s something that you’re apparently pretty good at. You offer consulting services to help doctors to get better at new patient marketing and acquisition. Could you just share a couple of offhand tips with us to give us an idea of the kind of things that you teach?

Madeleine: Yeah, absolutely, so I basically take people through a three-step system. And the number one system is really to clarify your marketing message, and so most chiropractors, right, when somebody asks you what you do, you say, “I’m a chiropractor,” And what happens immediately to patient or the person in front of you that’s hearing that, they immediately jump to assumptions about what chiropractors are based on their own experience and what they heard. And they’ll probably pretty quickly cross you off the list of somebody that they need or might need help with. And so if you actually answer it in a different way, that question becomes really powerful. One way is, you know, you know how teenagers are four times more likely to commit suicide than actually die from cancer because of anxiety and depression? And, well, what I do is to help teenager regain their happy or maybe teach them how to cope, and so they can live a long and fulfilling life. So that’s another way of answering that question, “What do you do?” It’s a much more engaging way of answering it, it’s a much more specific way of answering it. And actually gets people leaning in and curious about what you do.

And so, you know, you can come up with your own version of that depending on what you want to focus on. I think the biggest misconception when it comes to clarifying your marketing messages is that, “Oh, if I do it that way, then I’m gonna push away all these other people that I can help.” And we all know if somebody has a spine, they need to see a chiropractor, right? I’ve been getting adjusted for 27 years, so I get it. But I actually think when you’re really targeting your marketing message, people who you’re speaking to, when they hear your message, they feel that you’re speaking directly to them. And they get much more likely to take action and move closer to you and get to know what you do.

And so that is one of the powers of doing it, and so one of my clients, she was just doing this and she actually did focus on specifically what we’re talking about here. She focused on teenage anxiety, and we had this shooting down in Florida, right? A couple of months ago and she did a Facebook Live where she had a TV screen behind her with a picture of the shooter, and she was very emotional. You know, she’s a mom, she has teenagers. And she had printed out the printouts of the side effects of the drugs, the psychotropic drugs that these kids often are on. And she was reading the side effects of those drugs right from the sheet, from the printout and it was just very impactful, and she encouraged people to go and check it out. And within a couple of hours, that video went mini-viral on Facebook and thousands of people got it shared. And thousands and thousands of people started seeing it, and about 2:00 am that morning, a father reached out to her via private messaging and just said, “Listen, can you help my daughter? She’s talking about hurting herself and others and I don’t know what to do. She is on those drugs, she lost her mom and I’m at a loss. Can you help me? Can you help us?” And this chiropractor was then able to actually help this family get out of that situation, and I think that that’s the power of having a clear marketing message.

Daniel: I couldn’t agree more. In my work here at the magazine, I run across very, very frequently a business owner, or a company employee, who does not clearly understand the nature of their own business. They can’t concretely explain it in clear and simple terms. And chiropractors have a great deal of leeway. They can say, “I want to focus on spine health,” or, “I want to focus on helping people optimize their nervous system,” or, “I want people to have lives free from the dangers of drugs and their side effects.” Many different ways that that value proposition could be stated. And I hope our listeners will take a little time today and think about their own core marketing message if there might be other ways to say it in more compelling terms.

Madeleine: Yeah, and I know we have a little bit, limited time here, Daniel, today, so if they want the [inaudible 00:18:13], I can go over the steps or they can also download the e-book that I have. And we’ll give them the link to that before the end of today.

Daniel: Yeah, for people who’d like to follow-up and learn a little bit more about you and the work that you’re doing, where can they go online?

Madeleine: That’s you, right? So yeah, so basically, you know, we have created a very special page specifically for your listeners and where they can find both my Facebook group, a link to my Facebook group, “Healthcare Heroes.” And they can join for free and, obviously, I give away tons of information in there. They can also download my free e-book, which basically helps them attract patients on Facebook and how to do that effectively without wasting a bunch of money on ads or spending tons of time in front of the computer. And also taken a five-part, if you want to engage even more with people and create a community to really do the unknown to experts five-day course. It’s a free e-course and I’m only offering your podcast listeners, so they should check it out.

Daniel: Oh, that’s a great

Madeleine: That’s all on one page. Yeah.

Daniel: Okay, well, I’ve just been doing a little reading over the past couple of days just about your thoughts, and the work that you’re doing. You are a fascinating individual, you’re doing excellent work. And anybody who wants to follow up and learn a bit more from you, I think, will be extremely thrilled at the outcome. I want to thank you very much, Madeleine, for spending this time with us today. It’s been extremely informative and you’ve given us a revolutionary look at “The Future Adjustment.” I’m Daniel Sosnoski, I’ll see you next time.